Working-Age Disabled People

David Amess Excerpts

Thursday 25th October 2012 Westminster Hall

[Mr David Amess (in the Chair)]

A number of colleagues want to speak. I understand the time pressures and the arrangements, and I will accommodate everyone. I hope that we can work together so that everyone is satisfied in terms of their commitments. I call Anne Begg.

[Dame Anne Begg (Aberdeen South) (Lab)]

I am glad to hear you say that you hope to accommodate everybody, Mr Amess. Rather a lot of people have turned up, I am glad to see.

As Chair of the Select Committee on Work and Pensions, I shall speak to our report published in February. Although the title is “Government support towards the additional living cost of working-age disabled people”, most people know the issue as the switch from DLA to PIP, but we thought that that might be confusing, which is why we used the long title.

I begin with a declaration: since 1977, I have been a recipient of, first, the mobility allowance and then the mobility element of disability living allowance. Therefore, any changes to DLA will directly affect me in terms of the benefit for which I qualify. Some people might think it a handicap that I have to make such a declaration, but I hope that having been the recipient of the benefit in question gives me not a unique perspective, because everybody else who receives the benefit will feel the same, but an unusual perception and understanding, in parliamentary terms, of how important the benefit has been.

When I first qualified for the original mobility allowance, I was an impoverished student finding it difficult to get around. I certainly could not afford to own a car and did not come from the kind of family who could afford one, although I had been able to drive since the age of 17. The mobility allowance and then access to a Motability car revolutionised my life as a young teacher on a not particularly high wage. It made my life so much easier, and I have always paid great tribute to the late, lamented Lord Alf Morris, whose idea Motability was. He will be sadly missed for all the work he did in that area.

Returning to the report, the Select Committee’s first finding was that there is considerable scope for reform of DLA. Much of the evidence that we got, even from people who might be critical of the new scheme, admitted that many things about DLA perhaps needed to change. The claim form was long and complex, the criteria were not straightforward and there was no proper or rigorous system for reviewing awards where necessary. Having accepted the need for reform, many of the people from whom we took evidence went on to say that that could have been done by reforming DLA, and not necessarily by introducing a completely new benefit, although the Government said that the new benefit could represent an opportunity to address the problems of DLA while improving support for disabled people. In their response to our report, they said:

“These reforms present an ideal opportunity to start afresh, keeping the best elements of DLA… but bringing the benefit up-to-date in order to better reflect 21st century society.”

However—this is a big “however”—the Committee felt strongly that part of the problem was that the backdrop to the introduction of the reforms got them off to a poor start. The first knowledge that anyone had of an intention to reform, and indeed replace, DLA came not from the Department for Work and Pensions, but from a Budget document in 2010. Page 36 of the Budget policy costings said:

“This measure will introduce an objective medical assessment and revised eligibility criteria… The assessment will follow a similar process to the Work Capability Assessment (WCA) used for claims to Employment and Support Allowance, with a points based system to assess eligibility… the central assumption for this policy is that it will result in a 20% reduction in caseload and expenditure once fully rolled out.”

That was the introduction to the change. Because it mentioned a 20% reduction, people in receipt of DLA and many of the disabled organisations that represent them immediately felt that the reason for the change was not to improve the benefit, but to save money. The mention of the WCA and the fact that the Government would follow the kind of framework used for employment and support allowance also rang a large number of alarm bells among disabled people. By the time the Government’s proposals were published, the WCA had already obtained a bad name for being mechanistic, uncaring and unfeeling, and for getting assessments wrong. Putting all those together, we find that the principle of reforming DLA was somewhat overshadowed, because those to whom it would apply were immediately suspicious about the Government’s motives. We said in our report that we thought that that was unfortunate, because it certainly did not get the reform off to a good start.

It is true that during the process the Government listened to some of the criticisms. They dropped the proposals in the original draft of the Welfare Reform Bill to end the payment of the mobility component to care home residents. They also agreed, as the Bill went through the House, to extend the personal independence payment qualifying period, and it is certainly true that the first consultation on the first draft of the eligibility criteria produced some welcome changes, particularly on, for example, people’s ability to get around and preparing a meal. Important changes were made.

However, there are still a lot of questions. I hope that the Minister will not mind, but most of what I am about to say takes the form of questions. I know that she is a new Minister and keen, but I suspect that she will not be able to answer them all today. It will be good if she answers what she can. I know that she has already agreed to appear before the Select Committee some time in November; perhaps this debate will give her a taste of what we might ask her when the time comes. In some cases, she might be in a position to write to us with explanations, and about what has changed.

Part of the problem is that we do not yet know a lot of the detail of what will happen. The framework in the Welfare Reform Act 2012 was very vague. Everything is being done through regulation, but we still have not seen the final regulations. The most recent criteria were published in November 2011. Considering that PIP will be paid to new claimants from April next year, time is getting tight, and a lot of people are concerned about exactly how it will be tested and what the impact of the reform will be.

The first issue I want to raise is the lack of an impact assessment. Although the Government introduced the original PIP proposals in December 2010, it was not until January 2012 that they estimated the claimant count reduction—at about 500,000 people by 2015-16, which would be 23% of the claimant cohort. The published criteria included a number of hypothetical case studies that showed which types of claimant would and would not qualify for the new PIP, and at which rate. Crucially though, the case studies did not state whether, and at which rate, claimants would have qualified for DLA, so, without that information, it has been impossible to do a comparison and get an idea of who would and would not get the new benefit, and which types of claimant would lose out.

According to a survey published this week by the Hardest Hit coalition, entitled “The Tipping Point”, some 94% of disabled people fear that losing their DLA would be detrimental to their health, with 65% feeling that they would be unable to work and 75% saying that losing DLA would increase their local authority care needs. Without a full impact assessment, we are unable to answer a number of questions. How many people will lose their adapted Motability cars, and how will that affect their ability to work? Many people use a DLA care component to pay for local authority services, so what will the impact be on local authorities if those people do not qualify for PIP? What assessment have the Government made of DLA’s role in preventing people’s health conditions from worsening? What could the impact be on NHS budgets?

The Government need to consider the cumulative impacts on disabled people of welfare reforms, including the reform of DLA. We also have the 12-month time limit on contributory ESA, the incapacity benefit reassessment to move people on to ESA, cuts to local authority care budgets and the lowering of disability premiums under universal credit. Some claimants might be hit by only one or two of the changes, but some might have to deal with them all as they come in over the next three years. That would be an enormous change for them.

Our report said that we were glad to hear in evidence that there had been a form of co-production of the PIP criteria and the implementation of PIP, involving organisations that represent disabled people. However, we have spoken to some of those organisations, and they said that calling the PIP policy development “co-production” is somewhat absurd. There has been some consultation, but until we get the final assessment criteria, we, and they, will not know whether the Government have listened to them and acted. The Government consulted the organisations and might have heard what they had to say, but action is a different matter.

Disability groups have not been consulted about the framing of the PIP assessment contracts or the guidance to assessors, so, although there has been limited consultation, the wider implications of how the measure will work in practice have not been subject to any kind of co-production. In one meeting, the Disability Benefits Consortium told us that the documents had been counted in and counted up, and that it had been given 15 minutes to look at them. That, again, is hardly co-production.

On the PIP assessment, the Government have said that there will be a requirement for face-to-face assessments for most claimants. That also raises a number of questions. On what basis did the Government come to that conclusion? Will the Government not be able to take account of existing evidence in most cases? That leads me to a question on a slightly different point: will there be any transfer of information already held by the Department for Work and Pensions, so that people do not have continually to remind it of such things as, “This is a glass eye, and of course I am not going to see out of it.” That is not as daft as it sounds. Sometimes, when people have gone for a WCA they have been asked what vision they have in their left eye when they have not had a left eye for decades.

The Department clearly has that kind of information—for example, details of a claimant’s need for different formats—or information that highlights the fact that a claimant is particularly vulnerable or lives in a care home or supported accommodation, which might not be clear from their address, so will it be passed to whoever is administering PIP assessments so that people are not insulted by constantly being asked questions the answers to which would be obvious to anyone who knew them.

There is another question about the face-to-face assessment. Does an arbitrary decision to require a majority of claimants to undergo such an assessment not risk subjecting large numbers of disabled people to unnecessary stress and anxiety, and wasting a considerable amount of public money? I understand that the companies that might deliver the assessments have come up with wildly different figures for the number of home visits there will be.

The other concern regarding the PIP assessment relates to the assessment of fluctuating conditions, which has also been an ongoing problem with the work capability assessment. The activity descriptors attempt to capture the effect of fluctuating conditions by considering impacts that are present on over 50% of days, and that is a welcome change to the provision.

Where two or more activity descriptors apply on fewer than 50% of days individually but reach the 50% threshold when combined, the descriptor that applies for the greatest proportion of time will apply. However, people with such conditions can experience enormous fluctuations; one person might have a condition that fluctuates in such a way that they walk well one day but need an electric wheelchair the next. The difference between their good days and bad days is so extreme that they need the adapted house and all the equipment, although the bad days account for less than 50% of the time. Can the Minister shed some light on that?

The other big concern is the contracts. Atos has won the contract for two of the three areas that cover most of Great Britain, and Capita has won the other. Some of the criticism of the work capability assessment falls unfairly on Atos, and some of it perhaps not. Atos is delivering a contract that was written by the Government, so any problem with that contract is the Government’s responsibility. There has been little public discussion about what the Atos and Capita contracts will hold, so we do not know whether the Government are likely to get those contracts right.

One of the flaws of the WCA contract is that providers get paid for every assessment, regardless of whether they get them right, and right first time. On what basis will the providers be paid? The Committee argued that they should be paid for assessments that are right first time. There might be some leeway, but given the number of wrong WCAs there should surely be a penalty in the contract so that the companies would not be paid regardless of the accuracy of the assessments.

On top of that, will there be robust sanctions for provider failure? Will the Department look at the different approaches of the two providers and compare their accuracy and assessment reports? I think that will be crucial, a number of months in, in judging how the providers compare with each other and how they are doing. I know part of the reason why the Government adopted the framework approach to the contract, rather than a single contract covering the whole country, was, hopefully, to get that information and to see which provider was the most successful.

On the PIP assessments and the new assessments for the transition from IB to ESA, we recommended that the Government be sensitive to the timing of WCAs when scheduling PIP assessments. The Government should not underestimate the cumulative impact on vulnerable people of frequent reassessments. There is ample evidence that the WCA has been damaging individuals’ health and may be a factor in some suicides. The Government’s response to the Committee’s report was vague on that matter. They said they would try to ensure, where possible, that claimants will not be called for multiple face-to-face assessments in close proximity. How will they ensure that? Will there be data sharing from the part of the DWP that deals with employment support allowance and the part of the DWP that will deal with the new PIP?

The claim process is meant to be streamlined and very fast, which is to be welcomed, but that may cause some problems because it might be too fast for some people. We know the Government are saying that PIP claims should take about a month, yet, at the moment, the average waiting time for a citizens advice bureau appointment is six to eight weeks, which may be a problem for people who need expert help.

Will four weeks be sufficient to gather medical evidence and for vulnerable claimants to get the help and advice they need? How many people are likely to drop out of the process? If the claimant has a lifetime award, might they think that the reassessment does not apply to them? If the DWP does not hear back from people, will it send reminder letters to say that there may be an issue that has not been picked up? Again, some people will get the letter and think it is a circular, not realising that it is very specific to them and their position.

If the providers’ deadline is to be 30 days to make a judgment, and the end-to-end process is likely to take about two months, will there be flexibility in the time allowed to complete the end-to-end process to ensure that all relevant medical evidence can be collected?

What responsibility will the assessment provider have to seek relevant medical evidence? That is what happens at the moment with DLA, but it looks as if it might be different with PIP. Will all the evidence have to be supplied to the claimant? More crucially—again, this has been a problem with the WCA—who will pay for that medical evidence? Doctors, consultants and other health care professionals are being inundated at the moment with requests to provide such reports. Traditionally, they do not always charge the patient, although they do charge the DWP. Who is going to pay for, in some cases, multiple medical letters, especially as there is a good chance that a large proportion of claimants have a limited income?

Another thing is the scale of the task and the implementation timetable. As I have already said, new PIP claimants will start to be assessed next April. The figures involved are mind blowing. We as a Committee concluded:

“It is…essential that DWP allows itself sufficient time to get the assessment right and to be able to convince disabled people and their representatives that this is the case.”

It is very difficult to see how that can happen under the existing timetable. How can the DWP hope to learn from the early implementation of 10,000 new claims a week from April 2013 in time to implement new claims nationally from June 2013? The Department has from April to June to see whether the thing is working for new claimants. Why is there no pause before national implementation to make that assessment and see whether there is anything that has to change? We know that with all welfare benefit changes there are always unintended consequences and difficulties that people did not expect—they start hammering our doors, as MPs, saying, “This is what has happened.”

What happens if the assessments are found to take much longer than anticipated in the planning? What if there is found to be a greater need for home visits than was envisaged? All that takes longer. What if the descriptors are simply found not to work in real-life situations? I know there has been some testing, but there seems to be no time to test the final descriptors, which we have not seen yet.

I have done a very quick calculation—I suppose it is called a back-of-a-fag-packet calculation—that we have almost 2 million DLA claimants, and the Government will have 31 months end-to-end to assess all of them. We should remember that, to begin with, they will assess only 10,000 claimants a week, but the DWP will have to reassess some 70,000 claimants a month. That, in itself, is a huge amount. The calculation is fairly rough and ready, and I am not saying that that is the figure, but it will be in that ballpark.

The DWP is already assessing people for the move from IB to ESA. At the moment, the number is meant to be some 11,000 a week, but we know the providers are finding that incredibly difficult to manage. They are finding 11,000 a week—44,000 a month—difficult to achieve, and they will have 70,000 DLA/PIP assessments and 40,000 or 50,000 IB/ESA assessments to do, so to deliver their timetable they are looking at having to assess 100,000-plus disabled people face-to-face each month.

I do not think that is going to be possible, because I do not think there are enough health care professionals in the country for Atos or Capita to get through such a work load. I would not be particularly perturbed if the timetable slipped, which might be what is needed, but the Government have set a rod for their own back by trying to get so many people through the assessments when we know, anecdotally—we do not have the final figures—that they are really struggling to deliver the much lower numbers who are being put through the work capability assessment.

We know that being online might speed up the process—as a Committee, we have some concerns about that—but the online claims system will not be available for April 2013. Is that not indicative of a rushed implementation process? The most important thing is that we need the claimants’ outcomes to be tracked. Will the outcomes be tracked as part of an evaluation strategy? What monitoring will the Government put in place to ensure that all that is working and not falling apart?

Mr Amess, you will be glad that I am about to draw my remarks to a close because I know other people want to speak. I realise I have asked a lot of questions, and other colleagues will have questions, too, so I appreciate that the Minister will not be able to answer them all, but we look forward to taking evidence from her.

I have one last question on the legislative process. When will the final regulations and the final assessment criteria be laid before Parliament? Will the criteria be published in draft before the regulations are laid? If so, when?

We think that time is running out and that the Government have, unfortunately, started off on the wrong foot on what could be a useful reform by giving a lot of wrong messages to disabled people. It is understandable why disabled people feel that the reform is not to help them but merely a cost-saving measure.

The people who will be involved in the process are the most vulnerable people in society. It will be difficult for all of them, including those who will qualify for the benefit and for whom there is no doubt that they will qualify. If the WCA and the change to ESA are anything to go by, even those genuine claimants feel very stressed at having to go through this process. It is incumbent on the Government to get the process right and make it as easy for people as possible and to listen to the criticisms and do something about them, because the people who will lose out are those who need the money they receive through the DLA, and consequently PIP, to survive and have any kind of quality of life at all. They depend on that money to participate fully in society. I am sure the Government agree that that is the absolutely correct and laudable aim of any benefit, and they have to ensure that they deliver.

[Mr David Amess (in the Chair)]

I apologise to the hon. Lady for not addressing her by her correct title, which is Dame Anne Begg. Secondly, on behalf of the House, I should have welcomed her back after her awful accident, which I learned about in The House magazine. I am sure I speak for everyone in welcoming her back.

[Hon. Members]

Hear, hear.

--- Later in debate ---

[Several hon. Members]

rose—

[Mr David Amess (in the Chair)]

Order. The winding-up speeches will start at 4 pm. I do not want to impose a time limit and I want to call everyone, if we can share the time out.